Provider Demographics
NPI:1497424717
Name:WELLBRIDGE SURGICAL, LLC
Entity Type:Organization
Organization Name:WELLBRIDGE SURGICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-853-7392
Mailing Address - Street 1:6300 TECHNOLOGY CENTER DR.
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077
Mailing Address - Country:US
Mailing Address - Phone:317-432-7035
Mailing Address - Fax:
Practice Address - Street 1:6300 TECHNOLOGY CENTER DR.
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077
Practice Address - Country:US
Practice Address - Phone:317-432-7035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical